Urologists' Group Issues Updated Guidelines on PSA Test

Most younger men and those over 70 don't need prostate cancer screening; middle-aged men should talk with their doctor

FRIDAY, May 3, 2013 (HealthDay News) -- New guidelines from the nation's leading group of urologists on the controversial PSA test for prostate cancer highlight the importance of discussions between a man and his doctor.

Especially for men in their late 50s and 60s, the usefulness of the blood test may have to be decided on a case-by-case basis, according to new recommendations from the American Urological Association (AUA).

One expert called the new guidelines "a paradigm shift" in prostate cancer detection.

Dr. Louis Potter, chairman of radiation medicine at North Shore-LIJ Health System in New Hyde Park, N.Y., said the recommendations mark a move to more "personalized health management, where risk and age are balanced against the value of screening."

Prostate-specific antigen (PSA) screening is a test that measures the level of a key marker for prostate cancer in the blood. In general, the higher the level of this protein, the more likely it is that a man has prostate cancer, according to the U.S. National Cancer Institute.

The value of the PSA test has recently come into question, however, with several studies suggesting it causes men more harm than good -- spotting too many slow-growing tumors that, especially in older patients, may never lead to serious illness or death. In 2012, the U.S. Preventive Services Task Force, an influential government-appointed panel, advised against the routine use of the PSA test for prostate cancer.

The new AUA guidelines are more nuanced. The group does recommend against the PSA test for men under age 40 or for those aged 40 to 54 at average risk for prostate cancer.

The AUA says, however, that men aged 55 to 69 should talk to their doctors about the risks and benefits of PSA screening and make a decision based on their personal values and preferences.

Routine PSA screening is not recommended for men over age 70 or any man with less than a 10- to 15-year life expectancy.

The best evidence of benefit from PSA screening was among men aged 55 to 69 screened every two to four years. In this group, PSA testing was found to prevent one death a decade for every 1,000 men screened. But this benefit could be much greater over a lifetime, the guidelines noted.

The guidelines also said PSA screening could benefit men in other age groups who are at higher risk of prostate cancer due to factors such as race and family history. These men should discuss their risk with a doctor and assess the benefits and potential harms of PSA testing.

The new guideline updates the AUA's 2009 Best Practice Statement on Prostate-Specific Antigen and was announced at the association's annual meeting in San Diego on Friday.

"There is general agreement that early detection, including prostate-specific antigen screening, has played a part in decreasing mortality from prostate cancer," Dr. H. Ballentine Carter, who chaired the panel that developed the guidelines, said in an AUA news release.

There is more and better data about PSA screening available today than there was in 2009, so it is "time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms," Carter said.

One expert said the revised guidelines made sense.

"I think these guidelines are quite appropriate given the [slow-growing] nature of many prostate cancers," said Dr. Erik Goluboff, an attending urologist in the department of urologic oncology at Beth Israel Medical Center in New York City.

He agreed that discussions between a patient and his doctor on the PSA test are "extremely important."

"It has become increasingly evident that many, if not most, men diagnosed with early prostate cancer will never need treatment and can be spared the potentially devastating side effects of treatment such as urinary incontinence and erectile dysfunction," Goluboff said.

Some men, including black patients and patients with a family history of prostate cancer, may still decide to undergo PSA testing, he added. "This is in contrast to the U.S. Preventive Services Task Force, where a blanket statement that PSA screening is bad, regardless of individual patient risk, was made," Goluboff said.

A better test that pinpoints aggressive, life-threatening prostate tumors might be developed in the future, to better guide patients. "Hopefully, with discovery of better tumor markers, aggressive prostate cancers can be distinguished from [slow-growing] ones and only patients who need to will receive treatment," Goluboff said.

More information

The U.S. National Cancer Institute has more about prostate cancer screening (http://www.cancer.gov/cancertopics/pdq/screening/prostate/Patient/page3 ).

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.